Request a Mediation

For questions about whether a situation is appropriate for mediation, please call our Mediation hotline at (650) 345-PCRC (7272). Additional information about our program is included here.

To request a mediation, please complete the form and provide as much information as possible.

If you’re a third-party stakeholder referring others, please give them a courtesy notification before completing the form on their behalf. (Note: You do not need their voluntary agreement to participate to make a referral; PCRC will follow up and explore the process with them.)

When we receive your form, we will follow up with you and reach out to other parties within five (5) business days.

1. FIRST PERSON'S INFORMATION
Name *
Name
Phone
Phone
Address
Address
Languages Spoken
2. OTHER PERSON'S INFORMATION
Name 1
Name 1
Phone
Phone
Address
Address
Languages Spoken
3. ADDITIONAL PEOPLE INVOLVED
4. DESCRIPTION
5. FOR REFERRALS ONLY
To which service are you making a referral?
6. IF YOU ARE A RECOMMENDING 3RD PARTY
Your Name
Your Name
Affiliation
Phone
Phone